Atypical presentation of influenza A/H1N1 in a chronic kidney disease patient

There is currently little information about the presentation and clinical course of the 2009 pandemic influenza A (H1N1) virus infection in chronic kidney disease (CKD) patients on hemodialysis. CKD patients are at a high risk of H1N1 infection associated complications during this pandemic. H1N1 influenza is an important differential diagnosis in CKD patients on dialysis who are short of breath or febrile. We report an atypical clinical presentation of H1N1 influenza in a CKD patient. Uremia-induced immune dysfunction might lead to this atypical presentation. Hemodialysis patients are positioned close to each other during their dialysis treatment. Delayed diagnosis due to atypical clinical presentation of H1N1 might increase their exposure to transmission of respiratory infection. Physicians should be aware of this atypical clinical presentation of H1N1 influenza in CKD patients, especially during the flu season, for early diagnosis and prompt antiviral treatment.